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Writing on Race and Medicine

Damon Tweedy, MD, JD is an assistant professor of psychiatry at Duke University Medical Center and staff physician at the Durham VA Medical Center. He is a graduate of Duke Medical School and Yale Law School. His first book, Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine, comes out on September 8, 2015. He has published articles about race and medicine in the Journal of the American Medical Association (JAMA) and the Annals of Internal Medicine. His columns and op-eds have appeared in the New York Times, the Chicago Tribune, the Raleigh News & Observer, and the Atlanta Journal-Constitution.

Last month, I read an opinion piece by Dr. Tweedy in the New York Times, titled “The Case for Black Doctors.” He writes: “I’ve frequently been the only black doctor (or one of very few) in clinics with large black populations. Quite often, patients ask to see a black doctor, but the sheer volume of people seeking help prevents me from accommodating most of their requests.” I had the opportunity to chat with Dr. Tweedy about the points he raises in his article, his new book Black Man in a White Coat, and his inspiration for pursuing writing along with medicine.

V: What drew you to medicine, and specifically psychiatry?

Dr. Tweedy: I didn’t really have any childhood influences to speak of. I came from a working class neighborhood, and didn’t really know any doctors in any sort of personal way. I was a good student, and I tested into a science and technology magnet program, so it was around high school that I began to see medicine as a way to do good for communities and also have a rigorous and intellectually challenging profession. When I began to be interested in medicine, I was thinking a lot more around the lines of procedure-based specialties, but as I finished medical school, I felt that I really liked talking to people and getting to know them, and trying to help them through their problems. While procedure-based specialties were valuable, they had a more technical feel, and I got less gratification out of that.

V: I noticed you also went to Yale Law School, what prompted that?

Dr. Tweedy: When I went to medical school, I was looking at things from a basic science perspective. In college I was a biology major, sort of a traditional pre-med student. But when I got to medical school, I really saw how so many parts of sickness and illness were influenced by factors that were beyond biology and basic science, like social influences, economic influences, and political influences. So then I was thinking I was not even sure I was going to practice clinically, that maybe I’d get involved at the bigger picture policy level. Law school seemed like a good way of putting my feet into that world. That was my mindset, and I did that right after medical school. But then, as I was there, I realized that I really did like seeing patients, so that led me back to clinical training for residency.

Dr. Tweedy: One of the things I discovered when I was in medical school was that I really enjoyed narratives by physicians. A lot of medical journals had these sections where there’d be a narrative story or an essay written by doctors about their experiences in medicine. And I found myself gravitating more to those stories, those essays, than I did to the latest research. So I started with that, and then I began to read books written by doctors—there are now hundred—describing their experience with training and practice. I’m still a fan of those, but what I learned was that there was one aspect of the story, at least the story relevant to me, that was omitted. Most of these books talked very little about race in any way, whether from the perspective of the patient or the provider. In my own experience, these things affected me quite a bit, and so I really felt like there was a void I was filling. In a way, I was writing the book that I would want to read. It’s a memoir of my journey through medical training written through the lens of race. This is a story that seeks to humanize the statistics on health disparities and social inequality by putting my own experience and those of everyday black people front and center. Race is an important subject in medicine, but it’s one that has largely been overlooked in the many memoirs written by physicians. To me, this is a real omission when you consider the large number of leading medical schools and teaching hospitals located in areas with large black populations, where there has often been historical tension between these institutions and these communities. So I wanted to write a book that explored this dynamic and helped to fill this void.

V: When did you start writing the book?

Dr. Tweedy: Even in medical school, there would be some things that occurred that struck me. Writing was a way to process it and make sense of the experience. And that’s what I really enjoyed about reading the writings of other doctors—it was a way to make sense of what I was experiencing. Because in medical school, some of the things you see or do are very different than in any other aspect of life. I started in medical school just taking notes here and there, and then in my residency training started to do a little bit more of it. But it really wasn’t until I finished residency training that I really started to write the book in a more concrete way. So that’s been several years.

V: Do you have any examples from the book that you can share about things that happened in medical school or in residency that really made you feel that you had to tell this story?

Dr. Tweedy: I’m a doctor and there are different times when I’ve seen how patients are treated differently based on their race or socioeconomic status. And I’ve seen how that can influence medical care. Personally, there was one time I came to a clinic with pretty significant knee pain. It was an urgent care clinic, and I walked in there, and I had come from home and was very casually dressed. The doctor who saw me treated me pretty brusquely, he didn’t really make eye contact. Being a doctor, I mentioned to him that I had a medical background, and it was amazing how he suddenly changed and started interacting with me. It was almost as if he was treating two different people. It was a real illustration of how differently patients can be treated.

V: The points you make in your NYT article are interesting because there have been problems in hospitals with patients asking for only white doctors. I noticed there were a lot of comments on your article taking issue with the idea of black patients asking for black doctors. I was wondering how you react to those sort of comments.

Dr. Tweedy: It’s a great question. I think there’s a lot of growth that can occur across interracial situations. You mention white patients requesting white doctors and not wanting doctors of other races. I had an incident that’s really memorable that I write about in the book, where an elderly white man who described black people in racist terms and made it clear that he did not want a black doctor, ended up being assigned to the only team at the hospital that had a black doctor, me. I write about how that relationship evolved into something that would have been unimaginable at first. That evolved into a good relationship. My goal of the NYT article was certainly not to suggest we should segregate medicine and black people should see black doctors. I think that some people may have misinterpreted it that way. It’s just the idea of recognizing that it’s important to have that space or option to see a black physician. Nowadays you see many women who want a female provider, but for a long time that wasn’t even possible. I think the possibility of even having a black doctor needs to increase.

V: What do you want people to take away from your book?

Dr. Tweedy: Along with humanizing the experiences of black doctors and black patients, I also want to leave readers with a sense of hope. Despite the frequently negative dialogue on race, my experiences in medicine have often shown that people are capable of making strong racial connections when at first they seemed unlikely. Illness can often strip away superficial differences and allow powerful human connections to form. I think there are lessons from that realm which can be applied to everyday life.

About the authorVidya Viswanathan

Vidya is the founder of Doctors Who Create and is a third-year medical student at the University of Pennsylvania. She received her BA in Social Studies and a citation in Mandarin Chinese from Harvard College. She freelance writes about medicine and innovation, and has published in The Atlantic and MedTech Boston. Read her writing at www.vidyaviswanathan.com and follow her on twitter (@vidyavis).